DESCRIPTION: Dr. Monthaporn S Bryant is a physical therapist and an assistant professor in the University of Texas Medical Branch, Division of Rehabilitation Sciences, Galveston and an adjunct assistant professor in the Baylor College of Medicine, Department of Physical Medicine and Rehabilitation in Houston. Her research work has focused on the rehabilitation of persons with Parkinson's disease (PD) at the Michael E. DeBakey VA Medical Center (MEDVAMC) in Houston. Dr. Bryant has experience in rehabilitation intervention for gait, gait analysis and exercise in persons with PD, as well as experience in conducting clinical studies within the VA system. The aim of the proposed research project is to study the effectiveness of multidirectional treadmill training (MDTT) in improving gait and balance in veterans with PD. Despite advances in both medical and surgical treatments, postural and gait instability are still significant problems, and necessitate rehabilitative interventions. The project will target veterans with PD who experience gait difficulty, impaired balance, freezing and/or fall. The first phase of the study will develop dose-response profile of MDTT to be used in the second phase. The second phase will study the effectiveness of MDTT in both clinical and biomechanical quantitative outcomes. Clinical outcomes will include PD symptoms, clinical gait and balance evaluations. Quantitative evaluations will include gait kinematics and computerized posturography. The design will be a randomized, wait-list controlled trial to evaluate the efficacy of MDTT to improve gait and balance. The intervention will consist of walking on a treadmill at a fastest tolerated speed in 4 directions (forward, backward, sideways) while supported in a harness for safety. The training will occur 3 times per week for 8 weeks. Follow-up assessments will be obtained at 4 months after the end of MDTT. Veterans with PD will be recruited from MEDVAMC in Houston. Dr. Eugene C Lai (Neurologists), Dr. William Paloski (Biomechanics), Dr. Kenneth Ottenbacher (Rehabilitation), and Dr. Michele York (Neuropsychologist) are members of a mentoring team for supporting Dr. Bryant's interests and training goals. The specific purposes of this career development proposal are to: 1) understand overall management for PD, and correct use of standardized PD clinical scales; 2) develop a dose-response profile of MDTT to gait and balance; 3) study the changes from MDTT in both clinical and quantitative outcomes; and 4) study the influence of MDTT on cognitive function and other non-motor symptoms of PD. Dr. Bryant will be trained in overall management and assessment of PD, biomechanical measurement (motion analysis), data acquisition and interpretation, non-motor symptom and cognitive function assessment. These tools will be used for the assessment of changes from MDTT. PUBLIC HEALTH RELEVANCE: Relevance to Veterans Health: An estimated 40,000 Veterans with Parkinson's disease (PD) receive care from VA facilities annually; many have difficulties with gait and balance leading to falls and subsequence disability. The VA is committed to improving care and finding a cure for PD as evidenced by creation six Parkinson's Disease Research, Education, and Clinical Centers in the country. The proposal is highly relevant to the VA patient care mission. The proposed research seeks to demonstrate the efficacy of a new rehabilitative intervention to address gait and balance deficits and to better understand the possible mechanism underlying the intervention. Veterans with PD will be recruited to participate in the proposed study and the results will be generalized to other Veterans with PD who receive care from VA facilities. In summary, care and quality of life in Veterans living with PD will be improved.